Outcomes of mechanical thrombectomy in octogenarians and nonagenarians patients with Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis.

PURPOSE: Acute ischemic stroke (AIS) imposes a major healthcare burden, with the elderly population often underrepresented in clinical trials. This systematic review and network meta-analysis aims to evaluate the safety and efficacy of mechanical thrombectomy (MT) among octogenarians and nonagenarians with AIS due to large vessel occlusion (LVO). METHODS: A systematic search was conducted using PubMed, Web of Science, and Scopus databases. Outcomes of interest were modified Rankin Scale (mRS) score of 0-2, thrombolysis in cerebral infarction (TICI) score of 2b-3, 90-day mortality, and symptomatic intracerebral hemorrhage (sICH). The study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS: The analysis included 47 studies. Significantly lower rates of mRS score 0-2 were observed in nonagenarians (17.4 %) and octogenarians (21.3 %) compared to younger (40.2 %) patients (Odds Ratio (OR) = 3.30, 95 % Confidence Interval (CI):2.35-4.65 and OR = 2.47, 95 % CI: 2.07-2.94). 90-day mortality was significantly higher in nonagenarians (38.9 %) compared to octogenarians (25.4 %) and younger (14.0 %) patients (OR = 0.58, 95 % CI: 0.41-0.83 and OR = 0.31, 95 % CI: 0.21-0.44), and in octogenarians compared to younger patients (OR = 0.52, 95 % CI: 0.41-0.66). No significant differences were observed in TICI 2b-3 and sICH rates across groups. CONCLUSIONS: Our findings indicate that MT is a viable treatment option for AIS due to LVO among octogenarians and nonagenarians, albeit with nuanced differences. Specifically, octogenarians had lower 90-day mortality rates compared to nonagenarians. These insights support the need for individualized treatment plans for elderly patients with AIS due to LVO and highlight the importance of including this demographic in future clinical trials.

Region-specific interobserver agreement of the Alberta Stroke Program Early Computed Tomography Score: A meta-analysis.

BACKGROUND AND PURPOSE: The Alberta Stroke Program Early CT Score (ASPECTS) is a widely used scoring system for evaluating ischemic stroke to determine therapeutic strategy. However, there is variation in the interobserver agreement of ASPECTS. This systematic review and meta-analysis aimed to investigate the interobserver agreement of total and regional ASPECTS. METHODS: A comprehensive search was conducted in the Web of Sciences, PubMed, and Scopus databases to identify relevant studies. Inclusion criteria were studies of noncontrast CT performed within 24 hours of ischemic stroke in the middle cerebral artery territory. RESULTS: A total of 20 studies, with 3482 patients, reporting interobserver agreement of total and regional ASPECTS were included in the meta-analysis. The interobserver agreement for total ASPECTS in studies using Kappa coefficient (κ) analysis was substantial (κ = .67, 95% confidence interval [CI]: .57-.78). In studies using intraclass correlation coefficient (ICC) analysis, agreement was excellent (ICC = .84, 95% CI: .77-.90). Interobserver agreement was higher in studies in which the observer was unblinded to clinical scenario in both groups (κ = .74, 95% CI: .59-.89, and ICC = .82, 95% CI: .79-.85). Per-region analysis showed that the caudate nucleus had the highest agreement (κ = .68, 95% CI: .60-.76, and ICC = .84, 95% CI: .74-.93), while M2 and internal capsule in Kappa studies (κ = .45, 95% CI: .34-.55 and κ = .47, 95% CI: .28-.66), and M4 and internal capsule in ICC studies (ICC = .54, 95% CI: .43-.64 and ICC = .55, 95% CI: .18-.91) had the lowest agreement. CONCLUSION: This meta-analysis demonstrates substantial to excellent interobserver agreement for total ASPECTS, which supports using this method for stroke treatment. However, findings emphasize the need to consider interobserver agreement in specific regions of ASPECTS for treatment decisions.

Prevalence of positive findings of brain computed tomography scans in pediatric population.

Objectives: Computed tomography (CT) scans are used more frequently in medical centers, increasing unnecessary requests for it as a first-line evaluation. This study aimed to investigate the rate and prevalence of abnormal findings in a brain CT scan in children at the Children's Hospital of Tabriz, Iran. Materials &Methods: This study was a cross-sectional descriptive-analytical study that included all children under 15 years old undergoing a brain CT scan at the Children's Hospital of Tabriz, Iran. All patients who fulfilled the inclusion criteria and were referred to the Children's Hospital of Tabriz during the spring of 2018 entered the study. Age, gender, patient history, and clinical findings were examined. In the next step, the results of each patient's CT scan were evaluated. Results: In this study, 108 patients were studied with a median age of 18.0 months. CT scan results were normal in seventy-four cases (68.5%), hydrocephalus was seen in 15 (13.9%), and benign infantile hydrocephalus was seen in eight (7.4%). The study revealed a statistically significant relationship between patient history and CT scan results (p=0.017). A statistically significant relationship was observed between the clinical findings and CT scan results (p=0.042). Conclusion: Brain CT scans have more abnormal findings in patients with positive clinical findings. Although a CT scan is a highly sensitive and specificmodality in diagnosing central nervous system (CNS) abnormalities, its value depends on the underlying medical history and physical exam.

Computed tomography imaging findings in hospitalized patients with coronavirus disease 2019 (COVID-19): a descriptive study of 81 cases.

PURPOSE: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has proven to be a diagnostic challenge. Early studies have shown that computed tomography (CT) imaging may be useful in diagnosis of these patients. We aim to report CT findings in a series of hospitalized patients. MATERIAL AND METHODS: A total of 81 patients were included in this study. All of the patients were hospitalized and had SARS-CoV-2 infection proven by molecular assay. All patients had a CT scan on the first day of admission. Imaging results were reviewed by two separate radiologists, and imaging findings were documented. RESULTS: Seventy-eight patients had abnormal CT imaging, while 3 had normal CT imaging. The sensitivity of CT in diagnosing coronavirus disease 2019 (COVID-19) was estimated to be 96%. The most common imaging finding was ground glass opacities, followed by septal thickening. Most lesions were located at the periphery and posterior of the lungs. Most lesions were multifocal, and involved the right lower lobe more frequently. Chest X-rays were normal in 38 patients, and the sensitivity of chest X-ray in diagnosing SARS-Cov-2 was 54%. CONCLUSIONS: CT scans could be used in diagnosis of patients with a high sensitivity (93%). No common imaging findings may also be seen alongside ground glass opacities, based on the degree of disease progression.

Clinical Experience, Pathophysiology, and Considerations in the Prophylaxis and Treatment of Hypercoagulopathy of COVID-19: A Review Study.

Since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic, an increasing number of reports and studies have tried to warn the medical community about the thrombotic complications of coronavirus disease 2019 (COVID-19). It is suggested that the hyperinflammatory response and endothelial injury, especially in patients with severe disease, lead to a hypercoagulable state. Sudden deaths occurring in some patients also point to fulminant arrhythmias and massive pulmonary embolism (PE). Several expert panels have published recommendations regarding the prophylaxis and treatment of such complications. Nonetheless, there are limited high-quality studies for evidence-based decision-making, and most of these recommendations have arisen from descriptive studies, and optimal anticoagulant agents and dosages are yet to be designated. The coagulopathy persists after the acute phase of the illness, and some panels recommend the continuation of deep vein thrombosis prophylaxis for several days after regaining the normal daily activities by the patient. Here, we review the incidence and possible mechanisms of thrombotic complications, and present a summary of the considerations for the prophylaxis and treatment of such complications in the adult population.

Accuracy of diffusion-weighted imaging in discriminating atypical vertebral haemangiomas from malignant masses in patients with vertebral lesions: a cross-sectional study.

PURPOSE: Vertebral haemangiomas are incidental findings in imaging modalities. Atypical haemangiomas are haeman-giomas rich in vascular tissue, and they are found to be hypointense in T1 sequences and hyperintense in T2 sequences, mimicking the findings of metastatic lesions. In the present study we aim to evaluate the ability of diffusion- weighted imaging to differentiate these two groups of vertebral lesions. MATERIAL AND METHODS: In the present cross-sectional study, a total of 23 lesions were included, including 10 haemangiomas and 13 malignant lesions. Diffusion-weighted imaging was used to compare atypical haemangiomas and metastatic lesions. The apparent diffusion co-efficient was determined for each lesion, and then the mean of each group was calculated. The means were then compared. Receiver operating characteristic analysis was used to determine a cut-off ADC value to differentiate these lesions. RESULTS: The difference between the mean age of the two groups was not significant. The mean ADC value for atypical haemangiomas was 1884 ± 74 × 10-6 mm2/s and 1008 ± 81 × 10-6 mm2/s for the malignant lesions. The difference between the two groups was statistically significant (p < 10-3). ROC curve analysis determined an ADC value of 958 × 10-6 mm2/s to be able to differentiate between atypical haemangiomas and malignant lesions. CONCLUSIONS: Diffusion-weighted MRI could be used to differentiate between atypical haemangiomas and malignant metastatic lesions.

Breast artery calcification as a predictor of coronary artery calcification: a cross-sectional study.

INTRODUCTION: Coronary artery disease is the main cause of burden of disease in the world. Coronary calcification is seen as an aetiopathological event in the pathogenesis of cardiovascular diseases. Studies have shown that breast artery calcification, which is routinely found in mammography of elderly women, could be predictive of coronary artery calcification. MATERIAL AND METHODS: In this cross-sectional study, 60 women over 40 years of age were included. All of these patients had undergone mammography after having an indication to undergo a computed tomography-angiography. Breast arterial calcification and calcium scores were determined for each patient, and the paired-t test was used to analyse the data. RESULTS: The mean age of patients was 49.52 ± 8.83 years. Of these 60 women, 50% were postmenopausal and 50% were not. In 37 (61.7%) cases, mild to severe coronary calcification was observed, and 50 (83.3%) had mild to severe breast arterial calcification. There was a significant correlation between coronary calcification and breast artery calcification (p = 0.001), and there was also a significant relationship between coronary calcification and postmenopausal calcification (p < 0.001). CONCLUSIONS: Breast artery calcification can be a suitable predictor for coronary artery calcification and is a valid method for predicting cardiovascular disease probability in the future.

Predictors of coronavirus disease 19 (COVID-19) pneumonitis outcome based on computed tomography (CT) imaging obtained prior to hospitalization: a retrospective study.

PURPOSE: Computed tomography (CT) has been utilized as a diagnostic modality in the coronavirus disease 19 (COVID-19), while some studies have also suggested a prognostic role for it. This study aimed to assess the diagnostic and prognostic value of computed tomography (CT) imaging in COVID-19 patients. METHODS: This was a retrospective study of fifty patients with COVID-19 pneumonia. Twenty-seven patients survived, while 23 passed away. CT imaging was performed in all of the patients on the day of admission. Imaging findings were interpreted based on current guidelines by two expert radiologists. Imaging findings were compared between surviving and deceased patients. Lung scores were assigned to patients based on CT chest findings. Then, the receiver operating characteristic curve was used to determine cutoff values for lung scores. RESULTS: The common radiologic findings were ground-glass opacities (82%) and airspace consolidation (42%), respectively. Air bronchogram was more commonly seen in deceased patients (p = 0.04). Bilateral and multilobar involvement was more frequently found in deceased patients (p = 0.049 and 0.014, respectively). The mean number of involved lobes was 3.46 ± 1.80 lobes in surviving patients and 4.57 ± 0.60 lobes in the deceased patients (p = 0.009). The difference was statistically significant. The area under the curve for a lung score cutoff of 12 was 0.790. CONCLUSION: Air bronchogram and bilateral and multilobar involvement were more frequently seen in deceased patients and may suggest a poor outcome for COVID-19 pneumonia.

Diagnostic value of chest CT in Iranian patients with suspected COVID-19.

BACKGROUND: In the current COVID-19 pandemic, there is a rising need for a rapid and reliable diagnostic tool. We hypothesized that chest computed tomography (CT) can be a potential alternative for reverse transcription-polymerase chain reaction (RT-PCR). The aim of this study was to compare the diagnostic value of chest CT and RT-PCR in Iranian patients with suspected COVID-19. METHODS: In a retrospective, single-center case series, 568 consecutive hospitalized or outpatient patients with suspected COVID-19 underwent chest CT and/or RT-PCR testing at Imam Reza Hospital, the tertiary teaching hospital of Tabriz University of Medical Sciences in Iran, from February 21 and March 28, 2020. RESULTS: The sensitivity of chest CT for signifying COVID-19 was 64% (95% CI: 56%-71%) on the basis of positive RT-PCR results as a standard method. CT imaging also had a specificity of 77% (95% CI: 73%-81%), positive predictive value of 35% (95% CI: 0.31-0.39), negative predictive value of 66% (95% CI: 0.61-0.69), positive likelihood ratio of 2.79 (95% CI: 2.26-3.46), and negative likelihood ratio of 0.47 (95% CI: 0.38-0.57). CONCLUSION: Chest CT had higher specificity in the diagnosis of COVID-19 than that of the previous studies. Therefore, it can play a crucial role in the early diagnosis. Similar to the previous studies, the typical CT features were patchy ground-glass opacities as well as peripheral aspects of the lungs consolidations.

Primary pleural lymphoma of T cell origin in a paediatric patient with a focus on radiological findings - a case report and review of literature.

PURPOSE: Pleural lymphoma is a medical condition characterised by shortness of breath and obscure chest pain, which may be a diagnostic challenge, especially when it occurs in children. Plain chest X-rays and computed tomography (CT) scan are the main imaging techniques and are the initial diagnostic methods utilised. CASE REPORT: A four-year-old boy was admitted to the emergency ward with pain in the right thoracoabdominal region, which had persisted for two months. Physical examination revealed reduced respiratory sounds in the right chest, but with no other significant findings. The patient underwent chest X-ray and CT scan, which showed right sided pleural thickening coupled with a massive pleural effusion. The patient underwent pleural biopsy, and a diagnosis of T-cell primary pleural lymphoma was made. The patient underwent treatment with BFM-NHL and was followed for three years, during which the patient remained disease free. CONCLUSIONS: Pleural lymphoma is a rare diagnosis especially in children and could have overlapping clinical manifestations with more common conditions. Imaging techniques are the main route of clinical work-up towards final diagnosis. Here, we present a rare paediatric patient with no significant past medical history, who underwent imaging and was diagnosed with T-cell primary pleural lymphoma, a very rare subtype of primary pleural lymphoma.

Immunohistochemical study of cyclooxygenase-2 in skin tumors.

INTRODUCTION: Anti-cancerous effects of cyclooxygenase-2 (COX-2) inhibitors have been reported in different cancers. High expression of COX-2 has been demonstrated in various neoplasms such as colorectal, gastric, esophageal, breast, non-small cell lung cancers, and pre-neoplastic lesions such as colorectal adenomas and Barrett's esophagus. GOAL: The purpose of this study was to investigate percentage of positive COX-2 expression in skin tumors, including pre-malignant and malignant tumors. METHODS: This is an analytic cross-sectional study that includes 62 skin tumor samples, among which 49 samples were malignant and 13 were pre-malignant. After study for determination of pathologic kind of tumors, samples underwent immunohistochemical study for COX-2 expression. The DakoCytomation EnVision+System-HRP is a two-step extremely sensitive IHC staining technique which we used in this study. RESULTS: Among the skin tumors, a considerable number of COX-2 expression were found in squamous cell carcinomas (SCC) (16 of 17; 94%), basal cell carcinomas (BCC) (28 of 32; 87.5%), Bowen's disease (BD) (8 of 9; 89%), and actinic keratosis (AK) (4 of 4; 100%). CONCLUSION: COX-2 expression was positive in skin tumors including malignant and pre-malignant skin lesions. This study strongly suggests that COX-2 can be one of the molecular targets in treating various skin tumors.

Hydatid cyst in children: A 10-year experience from Iran.

BACKGROUND: Hydatid disease is one of the major world-wide health problems especially in endemic countries. Due to lack of statistics about this disease, various aspects of hydatidosis in children in North-West of Iran have been studied in this study. MATERIALS AND METHODS: We studied 59 children with hydatidosis referring Tabriz Children Hospital, Tabriz, Iran from 2001 up to 2011. We surveyed chief complaint of patients, number, size and location of cysts in children and also we studied cysts as if they are infected or ruptured or not. RESULTS: Average age of 59 patients (32 [54.2%] males and 27 [45.8%] females) was 7.93 ± 3.0. The most common chief complaints were cough and pain. Number of cysts was higher in females (2.00 ± 2.8 vs. 1.52 ± 1.0). The most common locations of cysts are lung and liver (52 patients); however, other organs had been also affected. CONCLUSIONS: Lung hydatidosis is more common than hepatic hydatidosis in children than adults and it is more frequent in males. Hydatid disease should be considered in differential diagnoses of liver and lung cystic lesions in children.

Study of ultrastructure and apoptosis in the endometrium of women with or without endometriosis.

BACKGROUND: More than 40% of infertilities are due to endometriosis. Ultrustructural and histochemical study of endometrium will help to clarify the etiology of endometriosis. OBJECTIVE: The aim of the present study was to investigate the ultrastructure and occurrence of apoptosis in endometrial cells of women with or without endometriosis. MATERIALS AND METHODS: In the present case-control study, endometrial specimens from 12 women without endometriosis (as control) and 12 women with endometriosis (as case) were examined. Specimens for control group were obtained from the patients that were referred to gynecology hospital for hysterectomy due to various reasons. In case group the endometriosis was diagnosed according to laparoscopy and endometrial samples were taken using pippel biopsy. The specimens from both case and control groups were processed for Transmission Electron Microscopy (TEM), TUNEL reaction technique and morphometric studies. RESULTS: The results show that endometrial epithelium lost its continuity in women with endometriosis and endometrial cells have euchromatic nucleus in comparison to those from non-endometriosis. There were several apoptotic cells in the luminal and glandular endometrial epithelium and stroma from endometrium of control group. However, apoptotic cells were rarely seen in the endometrium from women with endometriosis. The difference in number of apoptotic cells between two groups statically was significant (p<0.001). CONCLUSION: Regarding the ultrastructural characteristics of endometrial epithelial cells and comparison of apoptotic occurrence in control and case groups it is concluded that endometrial cells in endometriosis group have higher potential to survive and possibly implant.

Down-regulation of metallothionein 1 and 2 after exposure to electromagnetic field in mouse testis.

BACKGROUND: It is proved that testis is sensitive to electromagnetic field (EMF) and its damage results in infertility. Exposure to EMF induces reactive oxygen species production and affects on anti-oxidants defense mechanisms. Metallothionein (MT) is a name for a group of low molecular weight (6-7 kDa), sulfhydryl rich proteins. Expression of MT1 and MT2 genes in testis tissue after EMF exposure was aimed in this study. METHODS: Male BALB/c mice (8 weeks old) were exposed to 3 MT EMF for 8 weeks, 4 hours/day. After 8 weeks, the mice were sacrificed and the testis tissue was removed. The testis pieces were stained with hematoxylin and eosin and analyzed under an optical microscope. Assessment of MT1 and MT2 genes and also protein expression was performed by real-time PCR and Western-blot, respectively. RESULTS: In light microscopic observation, the number of primary spermatocytes was increased significantly in EMF group (P < 0.01). In addition, in interstitial space, the number of leydig cells was increased significantly in EMF group (P < 0.01) and basement membrane thickness was increased as well. MT1 and MT2 genes were down-regulated significantly in testis tissue of mice exposed to EMF both in mRNA and protein level compared to control. CONCLUSION: It is clear that MT is mediated in testis development and spermatogenesis. Down-regulation of MT1 and MT2 after EMF in mouse testis might be followed by some consequences that result in infertility.